Why young athletes need more than just time off to safely return to sports after ankle sprains, fractures, and lower body injuries.
It’s pretty common around here: a young athlete sprains their ankle or fractures a bone in the leg. They’re told to wear a boot, rest, and come back for a quick recheck in six weeks. If the bone looks healed, they get the green light for full return — sports, PE, everything.
The problem? Bones and tissues might look healed on an X-ray, but that doesn’t mean the leg — or the body — is ready for the demands of sprinting, cutting, jumping, or even just a full day of activity. Strength, balance, endurance, and basic loading capacity are often nowhere near where they need to be. As a result, kids return and still hurt. Or a new injury pops up. Or their performance falls off.
It’s not about bad care — most providers are doing exactly what they were trained to do. But there’s a disconnect, especially around here, between “cleared for activity” and ready for the load sports and life demand.
What Can We Do Differently?
Safe, early loading
We can start to safely load the injured structure and surrounding muscles earlier than many people realize. Controlled loading helps the tissue heal stronger.
Blood flow restriction training (BFR)
BFR can help strengthen healing tissue and the body as a whole without putting too much strain on the injury.
Strengthen the other side
Research shows that training the non-injured leg can help offset strength loss on the injured side and speed recovery.
Strengthen the rest of the body
Staying active and building total-body strength during recovery helps maintain fitness, improve outcomes, and shorten the time needed to get back to sport.
Movement re-training
We restore balance, stability, and confidence so the athlete isn’t just “pain-free” — they’re truly ready.
Basic Guidelines Before Return to Sport
- No limp — walking, jogging, sprinting all pain-free.
- Single leg hop test within 90-95% of the other leg (we test it).
- Strength testing for calves, quads, hamstrings, and glutes — with real numbers, not just “looks good.”
- Agility and change of direction drills without compensation or hesitation.
- Confidence — if the athlete doesn’t feel ready, they’re not.
We don’t guess. We test.
If you or your athlete has been cleared but still feels “off,” sore, or not like themselves, it’s worth getting a second look. There’s a smart, safe way to bridge the gap between “healed” and “ready.”
Drew Abatangelo, PT, DPT, SCS, OCS & John De Noyelles, PT, DPT, OCS, CSCS
